Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

Application of Patient Simulators Combined with Internet plus Scenario Simulation Teaching Models on Intravenous Infusion Nursing Education in China

Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.

Embracing different languages and local differences:Coconstructive patient simulation strengthens host countries’clinical training in psychiatry

BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

ESP机能数字人系统应用于机能实验学教学探索

为进一步提升虚拟仿真实验的教学效果,广州医科大学机能实验中心将电子标准化病人(electronic standardized patient,ESP)机能数字人实验教学系统应用于机能实验学课程的虚拟仿真教学,并对其实施效果进行了问卷调查。学生对该系统的总体满意度为93.8%。调查表明,这种新型的虚拟仿真实验教学系统值得进一步的应用与探索。

情景模拟联合SP教学在军校住培学员传染病学中的应用

目的探讨情景模拟教学联合标准化病人(standardized patient,SP)教学在军医大学毕业后教育中对住培学员的传染病学岗位胜任力的影响。方法选取2021年2月—2022年11月在海军军医大学第一附属医院感染科住培的65名军队规范化培训学员为研究对象,按照1∶1随机分为传统教学组(理论小讲课联合常规查房)和教改组(情景模拟教学联合SP教学)。通过理论考核、技能考核、日常评价、问卷调查等综合评估两组学员的传染病学岗位胜任力。结果教改组和传统教学组在理论考核总分、技能考核总分及总成绩差异均有统计学意义(P<0.05)。其中理论考核的主观题部分,技能考核的病史采集、体格检查、病例分析部分和医患沟通能力方面差异均有统计学意义(P<0.05)。问卷调查显示,教改组学员课程学习兴趣、认真参与程度、鼓舞临床热情、锻炼沟通表达和协同合作能力方面较传统教学组显著提高,起到很好的正向作用。教改组对带教形式和带教效果更满意,差异有统计学意义(P<0.05)。结论情景模拟教学联合SP教学可显著提升军医大学规范化培训学员的岗位胜任力,并将岗位胜任力转化为具体的临床行为,得到住培医师的高度评价。

氧化石墨烯/陶瓷球增强聚氨酯SPS复合板抗侵彻性能

无机填料的加入,能够较大程度增强聚氨酯的性能,从而使以聚氨酯为芯层的复合结构性能得到提升。为得到具有更好抗侵彻能力的SPS(sandwich plate system)复合板,利用原位聚合法得到氧化石墨烯增强聚氨酯弹性体并对其进行单轴拉压测试,在此基础上加入陶瓷球作为新的增强相,以Q235钢作为面板制备了芯层为石墨烯增强聚氨酯以及石墨烯/陶瓷球增强聚氨酯的SPS复合结构,通过钢球弹的侵彻试验并运用LS-DYNA数值仿真得到两种复合板的弹道极限速度,分析其吸能特性及损伤机理。结果表明:当石墨烯质量分数w=0.4%时,石墨烯增强聚氨酯的压缩模量较纯聚氨酯提高了32.4%,拉伸强度提高了42.6%;在加入陶瓷球后,复合板的弹道极限速度提高了20.8%,陶瓷球的碎裂和偏移中断了径向应力的传播,子弹尺寸以外的陶瓷球较为完整。

PBL结合SP教学法在中医院校内科学课程思政教学中的探索与实践

以基于问题学习(problem-based learning,PBL)教学法和标准化病人(standardized patient,SP)作为载体,有机融入内科学课程中的思政元素,是内科学思政教学的尝试,通过探讨PBL与SP相结合的教学模式在内科学思政教学中的实施路径与评价方式,实现内科学课程思政与思政课程同向同行,有效提升医学生的专业能力与职业素养,继而达到知识传授与价值引领的双重目标。

情景模拟联合SP教学在护士职业安全与防护课程中的应用

选择上海健康医学院护理专业某年级4个本科班229名学生为研究对象,按照整群随机分组的方法,分为实验组和对照组,实验组采用情景模拟联合SP教学法,对照组采用案例讨论教学法,以探讨情景模拟联合SP教学法在护士职业安全与防护课程中的实施与应用效果,为提高相关教学工作质量提供参考。

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Optimizing the Dosage Regimen of Micafungin against <i>Candida spp</i>in HIV Positive Patients with EC Based on Mote Carlo Simulation

The objective of our study was to explore the possibility of the antifungal efficacy of various micafungin dosage regimens against Candida spp in HIV positive patients with EC. According to pharmacokinetic/pharmacodynamics parameters of micafungin in HIV positive patients and MICs distribution of micafungin against Candida spp. in published studies, the dosage regimens of micafungin were 50, 100 and 150 mg QD iv. Monte Carlo Simulation analysed the probability of target attainment and cumulative fraction of response. The results showed that micafungin has good antifungal effect in treating HIV positive patients with EC when pathomycetes are Candida albicans, Candida glabrata or Candida tropicalis, in dosage at 100 mg QD and 150 mg QD.

基于SP的PICC维护情景模拟教学在转型医院实习护生中的应用

目的评价基于标准化病人的情景模拟教学模式在转型医院实习护生PICC维护培训中的效果。方法将在2020年4月—2022年2月在广西某三级甲等医院乳腺外科实习70名护理实习生分成对照组及试验组。试验组采用基于标准化病人外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)情景模拟教学模式,对照组采用传统的教学模式。观察两组护生的PICC维护理论、操作考试的成绩及护生对教学模式的满意度。结果试验组实习生的理论知识考试、操作考核成绩均高于对照组,差异有统计学意义(P<0.05)。护生的教学模式满意度高于对照组,两组差异有统计学意义(P<0.05)。结论基于标准化病人的PICC维护情景模拟教学模式可有助于提高护生PICC维护水平及临床思维能力,提升转型医院教师的教学能力。

Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the north-east of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test;z = &ndash;2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ2(2) = 1.946;p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

Patients' specific simulations of coronary fluxes in case of three-vessel disease

In this work, we propose a model of the coronary circulation based on hydraulic/electric analogy. This model aims to provide quantitative estimations of the distribution of flows and pressures across the coro-nary network for patients with stenoses of the left main coronary artery (LMCA), left anterior de-scending artery (LAD) and left circumflex branch (LCx), and chronic occlusion of the right coronary artery (RCA), undergoing off-pump coronary sur-gery. The results of the simulations are presented for 10 patients with various stenoses grades and collat-eral supply. For each patient, the four revasculariza-tion situations (no graft operating, pathological situa-tion (0G);right graft only (1G), left grafts only (2G), complete revascularization (3G)) are considered. It is shown that: 1) the complete revascularization is fully justified for these patients because neither the right graft alone, nor the left grafts alone can ensure a suf-ficient perfusion improvement for the heart;2) the capillary and collateral resistances (and the propor-tion between them) have a major impact on the flows and pressures everywhere in the network;3) in the presence of the left grafts, the flows in the native stenosed arteries become low and this could promote the development of the native disease in these branches.

Evaluation of undergraduate students’nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient

Objective:To evaluate nursing students’assessment and communication skills through an objective structured clinical examination(OSCE)within a high-fidelity simulation using a student-simulated patient(SSP)and analyze the validity,reliability,degree of difficulty,and discriminability of the OSCE.Methods:A descriptive study was conducted at one nursing school in Macao.All scenarios were designed using a high-fidelity simulator combined with SSPs.A convenience sample of 54 baccalaureate nursing students completed the OSCE.The nursing assessment OSCE checklist(NAOC)and the communication evaluation rubric(CER)were used as observational measurements with three-point Likert scales(2=Achieved,1=Partly achieved,0=Not completed/Incorrect).Results:Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills.The discrimination index of the majority items of the NAOC(86.4%)was>0.20,showing a better to good discriminability.The items of the CER had satisfactory indexes of item discrimination(from 0.38 to 0.84).Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment.Students presented good communication skills in eye contacting and listening,but culture assessment needs to be improved.The students with experiences in simulation or simulated patient(SP)interactions had better assessment and communication skills than students without those experiences.There was a positive relationship between nursing assessment and communication skills(r=0.67,P=0.000).Conclusions:SSPs were involved in enhancing the realism of interactions in simulated scenarios.Nursing students can conduct nursing assessments specific to patient conditions,explain the conditions to the patient,and ensure that the patient remains informed at all times of the precautions to be taken.However,students’cultural awareness and some communication skills need further training.With moderate difficulty and high discrimination index,OSCE showed satisfactory reliability and validity.

翻转课堂联合SimMan 模拟人在住院医师ACLS非技术能力培训中的应用

目的 本研究探讨翻转课堂教学法联合SimMan模拟人在住院医师高级心脏生命支持(advanced cardiac life support, ACLS)非技术能力培训中的应用效果。方法 选取西安交通大学第一附属医院80名三年级住院医师作为研究对象,将其随机分为翻转课堂组和传统课堂组,并应用SimMan模拟人进行ACLS的模拟培训。最后采用实践测试、非技术能力测试和问卷调查评估两种教学方法的培训效果。结果 翻转课堂组学员正确使用除颤仪得分、正确使用肾上腺素得分、团队合作得分及测试总得分高于传统课堂组学员,组间差异具有统计学意义(P<0.05)。较传统课堂组,翻转课堂组经过ACLS模拟培训后在情景意识、任务管理、团队合作及判断决策等非技术能力方面的合格率均明显升高(P<0.05)。问卷调查结果显示,翻转课堂组学员在良好的课堂互动、激发学习兴趣和积极性、加强团队合作和总体满意度方面优于传统课堂组,其差异均具有统计学意义(P<0.05)。结论 翻转课堂教学法联合SimMan模拟人可提高高年资住院医师的ACLS实践测试成绩和非技术能力,并增加学生满意度,在ACLS培训中具有重要的应用价值。

情景模拟结合CBL对提升产科住院医师医患沟通能力的效果分析

目的探讨在产科住院医师规范化培训(简称住培)中进行情景模拟结合以案例为基础的教学对医患沟通技能培训的效果。方法选取50名在产科规范化培训的住院医师为研究对象。培训前进行学员调查和医患沟通能力SEGUE测评。基于产科住培大纲选择5个典型病例情景,由教师录制5个典型病例病情医患沟通的示范视频,并梳理相关背景知识,在产科住院医师中依次开展培训课程,即视频示范、小组讨论、病例背景知识梳理讲解、分角色演练、演练后反馈和评价以及临床实践。培训后再次进行学员调查和医患沟通能力SEGUE测评。使用配对样本的非参数检验方法评价培训效果。结果情景模拟结合以案例为基础的教学的医患沟通技能培训后,学员医患沟通能力SEGUE测评总分提高[13.00(11.00~16.00)vs.22.00(20.00~24.00)],差异具有统计学意义(Z=-6.159,P<0.001);医患沟通能力SEGUE测评总体合格率提高[36.0%(18/50)vs.98.0%(49/50)],差异具有统计学意义(χ^(2)=43.464,P<0.001)。结论情景模拟结合以案例为基础的教学的医患沟通技能培训可有效提高学员医患沟通能力,调动学员的学习主动性,激发学员内在学习动力,建议在产科住培中纳入此类课程。

以流程图配合SSP教学对妇产科护生的带教效果评价

目的:研究妇产科护生带教中应用流程图配合SSP教学的效果。方法:选取本院妇产科60名护生并随机分组,对照组30名护生应用传统教学方法,试验组30名护生应用流程图配合SSP教学,评价并比较两组护生的教学效果。结果:试验组的理论与操作考核成绩、专业态度与学业自我效能感均高于对照组(P<0.05)。结论:流程图配合SSP教学优于传统教学方法,能够提高护生的理论知识和技能操作水平,促使护生建立积极的专业态度,并增强学业自我效能感。

标准化病人联合情景模拟模式下伤寒琢课程教考研究

目的明晰标准化病人(SP)联合情景模拟对伤寒琢课程的教学效果。方法选择2022—2023学年南京中医药大学中医专业本科大三班级A班(61人)、B班(61人)授课,每班总课时皆为36学时;其中A班采用36课时的伤寒琢理论教学,B班在A班基础上将36课时的伤寒琢课程拆分为24课时的理论教学及12课时的SP情景模拟教学。课程结束后分别考核两班中医临床诊疗操作、医德考核、SP打分(分别占20%)以及试卷考核(占40%)。此外,对两班学生进行杰弗逊共情量表学生版(JSE-S)的问卷调查,测试其共情能力。结果两班各有2人缓考,B班中医临床诊疗操作成绩、医德考核成绩、SP打分、试卷成绩、总成绩及JSE-S评分均优于A班,差异均有统计学意义(P<0.01)。结论运用SP联合情景模拟可提高伤寒琢课程的整体教学效果,同时提高学生的共情能力。

PBL教学法联合情景模拟在医患沟通教学中的应用

目的 研究以问题为基础的教学法(problem-based learning,PBL)联合情景模拟在培养住院医师医患沟通能力中的作用。方法 将2022年9—12月在中山大学孙逸仙纪念医院进行规范化培训的40名二年级住院医师随机分为试验组20名、对照组20名,试验组采取PBL教学法联合情景模拟教学,对照组采用PBL教学法,共4学时。教学过程中进行课堂教学效果评价。教学前和教学结束后,分别应用医患沟通技能评价量表(doctor-patient communication skills evaluation scale,SEGUE)对2组学员进行医患沟通能力评价,对2组得分进行统计学分析。2组均发放教学满意度调查问卷。结果 试验组课堂效果优于对照组,试验组住培学员在课堂气氛、师生互动、讨论活跃度、课堂注意力和学习积极性方面的评分高于对照组,差异有统计学意义(P <0.05)。试验组在教学完成后的SEGUE量表评分高于对照组,差异有统计学意义(P <0.001)。试验组满意度高于对照组,但差异无统计学意义(P> 0.05)。结论PBL教学法联合情景模拟能够活跃课堂气氛、增加住培学员的学习积极性,有效提高住院医师的医患沟通能力,优于单纯PBL教学法。

以药动学/药效学模型为基础的多种比阿培南 给药方案对于重症感染性疾病的抗菌效果

目的以药动学/药效学(PK/PD)模型为基础,采用蒙特卡洛模拟,针对重症感染患者的个体差异,设计比阿培南个性化用药方案以改善临床效果。方法收集重症患者比阿培南药动学参数,以常见致病菌大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌为目标菌株,引用中国细菌耐药监测研究报告中比阿培南对常见细菌最低抑菌浓度(MIC)值分布,通过调整给药剂量、给药间隔、滴注时间等方法制订不同给药方案,应用蒙特卡洛模拟计算各目标菌株不同给药方案的药效学获得概率(PTA)和累积反应分数(CFR),评估各给药方案治疗重症感染的抗菌效果。结果当MIC<0.125 mg/L时,比阿培南对5种目标菌株所有给药方案PTA值均>90%;当MIC≥4 mg/L时,所有给药方案PTA值均<90%;比阿培南对大肠埃希杆菌所有治疗方案CFR值均>90%,对鲍曼不动杆菌CFR值均<30%。结论比阿培南对大肠埃希菌的治疗可采用传统给药方案;对肺炎克雷伯菌的治疗可选择600 mg q6 h延时滴注3 h为最佳治疗方案,或根据MIC值优化给药方案;对于鲍曼不动杆菌、铜绿假单胞菌及金黄色葡萄球菌,应考虑换用或联用其他抗菌药物以达到疗效。